ONLY ONE SURVEY CAN BE
COMPLETED PER HOUSEHOLD
We recommend you complete the survey with members of your household. This is an opportunity to spend time together and discuss important topics.
 
 
You are invited to participate in the second annual Determinants of Health Household Survey, which is part of Kitselas First Nation's commitment to community health and safety. We need to track and monitor conditions, since many changes are happening in our traditional territory and the communities we live in. COVID-19 has been a very difficult time for everyone. By completing this survey, we will better understand how to promote and protect community health and wellness.
 
This household survey is being conducted by Kitselas First Nation and should take approximately one hour to complete.

PARTICIPATION: Your participation in this survey is voluntary. You may refuse to take part in the survey or exit the survey at any time without penalty. You are free to decline to answer any question you do not wish to answer for any reason.
 
BENEFITS: Your household will receive a $50 grocery gift card once you complete the survey and be entered into a draw to win one of three $200 grocery gift cards.  The draw will take place once the survey closes.  If you live in Kulspai or Gitaus, the gift card will be dropped off at your house. If you live elsewhere, the gift card will be mailed to you.
 
RISKS: Since this survey is on the topic of health and wellbeing, there is the risk that you may find some of the questions to be sensitive and answering them may cause emotional discomfort.

CONFIDENTIALITY: Your survey answers will be stored in a password protected electronic format. You will be asked to provide your name, address and contact phone number for two reasons: (1) If portions of your survey are left blank, a survey team member will contact you to provide assistance; (2) so we can give your household a grocery gift card. Your personal information will remain confidential. Your personal information will not be attached to data outputs or reports. 

CONTACT: If you have any questions about this survey while you are completing it please text/call: Pat Squires (250-615-1296), Laura Jokinen (250-240-1717) or Janis Shandro (250-951-6776)

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* 1.
ELECTRONIC CONSENT: Please select your choice below. Clicking on the “AGREE” button indicates that
  • There are THREE pages to the survey, at the bottom of the screen you will need to click the "NEXT" button 
  • You have read the survey information provided above  
  • You voluntarily agree to participate
  • You are 18 years of age or older
  • You understand the survey will take one hour to complete
  • You agree to be contacted by a survey team member if portions of your survey are left blank
  • Only one survey entry is allowed per household

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* 2. What is your name?  (this information will not be attached to survey data)

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* 3. What is your current home address? (this information will not be attached to survey data)

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* 4. What is your phone number?  (this will not be attached to survey data and is only needed to distribute gift cards)

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* 5. Where is your home located?

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* 6. Is your home shared by multiple families/relatives and/or roommates?

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* 23. If you have children/youth who are in elementary or secondary school living in your home where do they receive their schooling:

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* 24. Since the COVID-19 pandemic have the children/youth changed the primary method of learning and education (e.g. switched from attending public school to online learning at home or homeschooling)?

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* 27. Please select the statement that best describes the amount of space available in your house.

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* 28. Do you have internet access in your home?

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* 29. Is the internet in your home RELIABLE and FAST?

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* 32. On a typical day, about how many hours do the children/youth (17 years or younger) you live with spend in front of a screen (e.g., TV, computer, tablet, smart phone)?

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* 33. If you were to describe the condition of your home which statement best applies:

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* 34. Are you worried about the current condition of your home?

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* 35. Have you accomplished any household repairs over the past 12 months?

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* 36. Do areas of your home currently have a musty or moldy smell?

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* 37. Does your house currently have visible mold (e.g., in kitchen or bathroom)?

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* 38. Has your home suffered from water damage in the past 12 months?

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* 39. If yes, has the cause of the water damage been addressed and fixed?

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* 40. Where do you get your drinking water?

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* 41. How is your house heated?

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* 42. In the winter, does your home get warm enough to feel comfortable?

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* 43. Did your household engage in gardening last year (2020)?

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* 44. If you live in Gitaus or Kulspai, did your home participate in the garden box program?

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* 45. If you live in Gitaus or Kulspai, does your household want to participate in garden box program this year (2021)?

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* 46. What is your household’s primary method of transportation?

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* 47. Is the transportation available to your household reliable?

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* 48. Is the transportation available to your household affordable?

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* 49. If there are children/youth living in your home, how do they get to school?

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* 50. In the past 12 months, has anyone living in your home hitchhiked?

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* 53. During the past 12 months, what has been your household’s main sources of income? Please select all that apply.

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* 54. What statement best describes the current financial situation of your household?

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* 55. Has your household’s income been negatively affected by the COVID-19 pandemic?

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* 56. Has anyone in your household lost employment due to the covid-19 pandemic?

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* 60. Where do members of your household generally access non-emergency health care services?

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* 61. In your opinion, do your local health services meet your household health needs?

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* 62. Does everyone in your household currently have a family doctor?

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* 63. Do the elders living in your home feel they receive good healthcare (their health needs are being met)?

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* 64. Does anyone living in your home need to travel (more than one hour) to access health services?

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* 66. Since the COVID-19 pandemic (March 2020), has a household member been unable to access health services when in need?

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* 67. Do members of your household require a health service that is currently unavailable or difficult to obtain?

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* 68. In your opinion, what community-based services best support substance abuse recovery for Kitselas people (select all that apply)?

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